CGHS - Medical Treatment at Private Hospitals

CGHS – Medical Treatment at Private Hospitals empanelled under Central Government Health Scheme for central government employees and pensioners – Procedure

Department of Health and Family Welfare has recently relaxed certain procedures relating to Medical Treatment for central government employees and pensioners at Private Hospitals empanelled under Central Government Health Scheme. As per OM dated 01.01.2013, a Central Government Employee / pensioner or his / her dependents can under go investigation and medical treatment at CGHS approved hospitals once such specialized treatment was required as per the prescription of CGHS medical officers without any additional permission of CGHS authorities.

Click here to read more about relaxation given by CGHS for medical treatement in private hospitals under CGHS

City wise List of Private Hospitals approved under CGHS

Other procedures regarding treatment in private hospitals under CGHS are given in questions and answers form by CGHS in its website. Full text of the same is given as follows

Can I get permission for any Pvt Hospital of my choice?

Yes, provided the Hospital is empanelled for that particular procedure.

Can I opt for better implant by meeting extra cost over and above the ceiling? If yes,how?

Yes,you can.you will have to give an undertaking to the Hospital to that effect.

1.	From where can I get the Specialist consultation as I am suffering from Diabetes and heart disease	Either the Visiting Specialist in WC ( by Appointment ) Or In CGHS Wings of Safdarjang Hospital and Dr. RML Hospital in Delhi Or Specialists of any Govt. Organizations in Delhi and other cities Or Specialists of Pvt Empanelled Hospitals of satellite towns in NCR region upon referrals by CMO I/c of WC
2.	I am entitled for Direct Consultation and Nursing Home facility at Govt Hospitals, Can I go directly for consultation at Govt. hospitals	Yes with prior appointment
3.	I am entitled for Direct Consultation and Nursing Home facility at Govt Hospitals, Can I go directly for consultation at pvt empanelled Hospitals	No. Except the Specialists of Pvt Empanelled Hospitals of satellite towns in NCR region upon referrals by CMO I/c of WC
4.	In emergency who are all entitled to get treatment at Pvt Empanelled Hospital	Any beneficiary holding a Valid CGHS card.
5.	Do I get treatment on credit in emergency at Pvt empanelled Hospital?	Yes, on production of Valid CGHS card
6.	I want to get my Cataract Surgery done at Pvt empanelled hospital ? How can I get it done	Get a Govt. Specialist advice Pensioners to Apply to CMO I/c of WC for permission Serving employees to apply to Head of Deptt. of office
7.	Can I get permission for any Pvt Hospital of my choice?	Yes, provided the Hospital is empanelled for that particular procedure.
8.	How to know which Hospital is empanelled for what purposes / facilities?	Information is available on CGHS Website and on Notice boards of all CGHS WCs
9.	Is there any updated Govt. publication on CGHS facilities available for sale?	Not at present
10.	Is it necessary that the Govt specialist should write ”referred to CGHS empanelled Hospital “for obtaining permission?	No.
11.	I am a serving CGHS beneficiary. Can I get treatment on credit at Pvt. empanelled Hospital in emergency?	Yes.
12.	In charge does not refer me to Pvt Hospitals on my request?	As per CGHS guidelines OPD referrals are not permissible except in satellite towns of NCR
13.	I am a serving beneficiary. Can I get treatment on credit in non-emergency on producing permission from my office?	No. You will have to make payment and claim reimbursement.
14.	Is cost of implants reimbursed?	Yes.As per ceiling fixed by the Govt.
15 .	Can I opt for better implant by meeting extra cost over and above the ceiling? If yes,how?	Yes,you can.you will have to give an undertaking to the Hospital to that effect.
16.	As a serving beneficiary making payment for my treatment at Pvt.empanelled Hospital.Do I get any rebate while paying the bill?	Yes. The hospital will allow 5% rebate on the bill.
17.	Can I get advance from my office for treatment in Pvt Hospital as I have obtained permission on the recommendation of a Govt specialist?	Yes. You can apply for 90% of the package rates as advance.
18.	I am a CGHS Pensioner beneficiary receiving treatment in AIIMS	It is a Govt. institute, Still I have been asked for payment in advance Will CGHS give me advance Yes 90 % advance is given Apply through CMO i/c with an estimate from Treating Doctor and all relevant documents
19.	I am entitled for Private ward facilities. The hospital has charged 15% extra for investigations even though the investigations are performed on OPD basis. Is this correct?	No. Charges for investigations are same for all categories whether investigated as In patients or Out patients.
20.	The Pvt empanelled Hospital ask me to make payment even in an emergency. what to do?	Do not pay Make a complaint to AD / JD of the city
21.	I suffered a fall .I suspect a fracture.Can I go to a diagnostic center in an emergency for xray?	In emergency you are expected to seek treatment in a hospital which also has diagnostic facilities.
22.	I am an accredited journalist with CGHS Card Can I seek treatment in Pvt empanelled Hospitals in emergency and get credit facility?	No. Journalists are entitled only for OPD treatment from dispensaries and treatment from Dr.RML Hospital. Journalists are not entitled for reimbursement and are not entitled for treatment from empanelled hospitals.
23.	The specialist recommends me to go a particular Pvt hospital but it is too far from my residence. Can I go to a nearby empanelled Hospital?.	Yes. Specialists are expected only to advice a specific line of treatment and are not authorized to refer to any identified centre. The choice of the Hospital is of the beneficiary.
24.	I am a serving employee of an autonomous body ,holding CGHS card. who will give me permission for treatment on the recommendation of Govt specialist?	Office of the serving employee.
25.	I am a pensioner beneficiary of an autonomous organization, having valid CGHS card. Can I obtain permission for treatment at Pvt Hospital from CMO I/c of wellness center?	No. Pensioners of autonomous organizations will be granted permission by their respective offices.
26.	I am a pensioner beneficiary of Kolkata. In case of emergency, can I get treatment on credit at any empanelled Pvt Hospitals in other CGHS cities when I am on a visit to such city?	Yes.
27.	I want to take treatment in a non-empanelled Hospital of my choice for my planned surgery, recommended by Govt specialist Can I get reimbursement at CGHS rates.?	Permission is granted only for empanelled hospitals. No reimbursement is allowed for taking planned surgery in a non-empanelled hospital.
28.	In case there is no CGHS prescribed ceiling for an implant, what is the cost reimbursable in such a case?	As per actual.
29.	There is no facility for the treatment advised by Govt specialist in Pvt empanelled Hospital in the CGHS city I am residing. Can I get T A for travelling to and fro for my treatment at nearby CGHS city?	Yes. TA is admissible to the nearest CGHS city only when treatment facilities are not available in city of residence.
30.	I am denied treatment at CGHS rates and on credit in emergency in a Pvt empanelled Hospital as I did not carry my card. Is this correct?	Yes, Facilities under CGHS at Pvt empanelled Hospitals are available to the beneficiaries on production of a valid CGHS card.
31.	I have been advised Dentures by Govt Hospital Dental Surgeon Will CGHS provide me	Apply to AD / JD of city through CMO I/c of WC Submit Photocopies of Valid CGHS Card & Specialist Advice Permission shall be granted for dentures @ Rs. 2000 / max. and submit the medical claim for reimbursement
32.	I was advised Cataract surgery by Govt. specialist. I took permission for pvt. Empanelled hospital . Shall I be reimbursed the full cost of lens.	Reimbursement shall be made as per CGHS rates Rates are available on CGHS Website.
33.	I have been advised BTE Hearing Aid by ENT Specialist. Will CGHS provide me Hearing Aid	Apply to AD / JD of city through CMO I/c with Copy of Govt. Specialist advice Copy of Audiogram Copy of Valid CGHS Card Undertaking that no hearing aid has been received from CGHS in the past five years Permission shall be granted to you. Ceiling rate is Rs. 10,000 /- Medical claim may be submitted after purchase of Hearing aid.
34.	I have been advised Digital Hearing Aid by ENT Specialist. Will CGHS provide me Digital Hearing Aid	Apply to AD / JD of city through CMO I/c with Copy of advice of two Govt. Specialists of different hospitals Copies of two Audiograms Copy of Valid CGHS Card Undertaking that no reimbursement for hearing aid was received from CGHS in the past five years. Permission shall be granted for Digital Hearing aid with a ceiling rate of Rs.30,000/- Medical Claim may be submitted after purchase of Hearing Aid.
35.	Do Pvt. Empanelled laboratory Centers provide free home collection facility as per CGHS	agreement No
36.	I have been advised CPAP / BI-PAP / Oxygen Concentrator machine by specialist. How can I get it	Apply to AD / JD of city through CMO I/c of WC along with copies of advice (from Deptt. of Respiratory Medicine of Govt. hospital) and medical documents for permission to procure CPAP / BI-PAP machine Expert Committee shall examine and as per the recommendation of the expert committee permission shall be granted for purchase of the machine.